Navigating Menopausal Skin

Menopause – a time of wisdom and independence, but for our patients it is often synonymous with collagen loss, increased wrinkling, and those perplexing bruises that suddenly appear on the forearms. The exit of oestrogen triggers a cascade of changes, with skin taking the hardest hit. In clinic, we see this in the form of sagging, thinning, and an increase in visible vascular changes like telangiectasias. For menopausal skin, simply recommending a moisturiser isn’t enough. A more integrative approach is essential.

COLLAGEN’S FREEFALL

Oestrogen is vital for maintaining skin structure, particularly in preserving collagen. Post-menopausal women can lose up to 30 percent of their collagen within the first five years of menopause. This leads to rapid declines in skin thickness, elasticity, and repair capacity. Patients experience sagging, particularly around the jawline, deepening wrinkles, and general skin laxity. Beyond the face, areas like the forearms, hands, and even shins also reflect this collagen depletion.

What is sometimes overlooked is the impact on the structures beneath the skin, especially capillaries. With less collagen supporting these blood vessels, they become more fragile, leading to easy bruising and the appearance of telangiectasias. Combined with the vascular changes triggered by hot flushes, the result is red, blotchy skin – “hot mess” patients frequently complain about. Additionally, decreased oestrogen levels cause a dramatic drop in skin hydration, leaving the skin dry, flaky, and less resilient. The loss of oestrogen disrupts the balance of testosterone, which, to the frustration of many women, leads to the unwelcome reappearance of acne – a paradox where dryness and breakouts coexist, adding to the complex set of symptoms we need to manage for our patients.

THE SHIFT

The beauty industry has finally acknowledged that women over 40 need more than just a generic anti-wrinkle cream. A wave of new brands, like Stripes, founded by Naomi Watts (who clearly knows a thing or two about ageing gracefully), are now targeting this demographic with products specifically addressing hormonal skin changes. These formulations often contain plant-based mimetic and powerful peptides designed to tackle skin thinning, dryness, and collagen loss.

In South Africa’s aesthetic market, the focus should be on curating targeted, ingredient-driven solutions that complement the clinical treatments offered. Alongside this, wellness and integrative medicine clinics that focus on hormonal health are becoming more mainstream, offering personalised hormone assessments, bioidentical hormone therapies, and supplement regimens to support skin from the inside out. By addressing the root causes of hormonal shifts, these integrative approaches are helping to create a more holistic model of skin care that aligns perfectly with the aesthetic treatments we provide.

CLINICAL SOLUTIONS

Topicals

Managing menopausal skin is like balancing a house of cards in a windstorm. It requires stimulating collagen, while preserving the skin barrier and maintaining hydration. Retinoids are the gold standard for boosting collagen, but menopausal skin is often sensitive, so gentler options are crucial. Retinoic acid derivatives like tretinoin act directly on fibroblasts to increase collagen synthesis and dermal thickness but can be irritating. Traditional retinoids, such as retinol and retinaldehyde, require conversion to retinoic acid, reducing their potency. However, granactive retinoids bind directly to retinoid receptors (RARs and RXRs) without needing conversion, offering powerful collagen-boosting benefits with minimal irritation. Additionally, lipid-soluble Vitamin C options, like tetrahexyldecyl ascorbate, penetrates deeply to stabilize collagen fibers while protecting the skin barrier, making them an ideal, better tolerated complement to granactive retinoids for menopausal skin.

Together, these ingredients deliver effective anti-aging benefits while minimising the risk of irritation, making them the best options for treating sensitive, mature skin. Supportive skin barrier-boosting functional actives, such as ceramides and hyaluronic acid, are essential to replenish the skin and increase tolerability to higher, more efficacious concentrations of these functional actives.

Beyond retinoids, other collagen-stimulating options, such as peptides, exosomes, growth factors, and stem cells, are powerful tools for support skin rejuvenation. These cutting-edge ingredients work on a cellular level to accelerate repair and boost collagen synthesis without the irritation often associated with traditional actives. Preserving existing collagen is equally crucial, which is why daily use of broad-spectrum SPF and antioxidants like resveratrol – the ‘longevity molecule’ – is essential to protect against UV damage and oxidative stress, ensuring long-term collagen integrity.

To address vascular fragility and telangiectasias, especially exacerbated by hot flushes, ingredients that fortify capillaries while calming redness and strengthening the lipid barrier are necessary. Soothing agents like niacinamide, green tea extract and licorice root help manage flush-related redness and inflammation effectively.

DIET AND SUPPLEMENTS

An integrative approach also includes dietary advice. Phytoestrogen-rich foods like flaxseeds, sesame seeds, and tofu can naturally boost oestrogen levels. While collagen supplementation shows potential for improving skin hydration and elasticity, the evidence remains somewhat controversial. Some studies suggest that hydrolyzed collagen may support skin health, but the exact mechanisms and efficacy are still being debated. If prescribed, it should always be combined with its collagen-producing co-factor, Vitamin C.

To effectively address menopausal skin concerns, a variety of nutraceuticals that stimulate collagen production and combat oxidative stress should be integrated. Call-outs include (among many others) polypodium leucotomos, resveratrol and carotenoids, which offer protective effects against UV damage while reducing redness. Antioxidants such as astaxanthin and CoQ10 boost skin elasticity and moisture levels, while supporting cellular energy and vitality. NAD+ supplements play a key role in cellular repair and longevity, while Vitamin A promotes cell turnover to mitigate hormonal fluctuations.

Omega-3 fatty acids maintain skin barrier function and hydration, and nicotinamide (Vitamin B3) improves barrier integrity and stimulates collagen production.

Additionally, pulse isotretinoin treatment can stimulate collagen production and enhance skin texture while combatting menopausal-triggered breakouts. By incorporating these nutraceuticals into a comprehensive skincare regimen, we can help patients maintain healthy, vibrant skin during the menopausal transition and beyond.

IN-OFFICE PROCEDURES

For patients seeking faster, more dramatic results, in-office procedures can provide both immediate cosmetic improvement and longer-term structural support. Options like chemical peels, laser resurfacing, and broadband light (BBL) treatments can improve skin texture and minimise redness. Techniques like platelet-rich plasma (PRP) therapy, skin boosters, and Profhilo deliver hydration and stimulate collagen synthesis, while bio-stimulators, microneedling and radiofrequency tightening treatments provide additional collagen-boosting benefits. Combining these advanced modalities offers comprehensive solutions tailored to the unique challenges of menopausal skin, enhancing resilience and youthfulness. These treatments can be particularly beneficial in areas beyond the face, such as the neck, décolleté, and forearms, where collagen loss and vascular fragility can be more noticeable. Menopausal women are often looking for whole-body solutions, and we should be proactive in addressing areas they might not mention.

As we navigate the ever-evolving landscape of menopausal aesthetic care, the future promises a more compassionate and personalized approach. By empowering women to celebrate their natural beauty and resilience during menopause, we transform what was once viewed as a challenge into an opportunity for renewed vitality and self-expression. So, let’s raise our glasses (and our serums) to menopausal skin—a journey filled with laughter, wisdom, and a whole lot of fabulous!

DR VANESSA LAPINER

Dr Vanessa Lapiner is a dermatologist based in Cape Town with key interests in integrative dermatology, mole mapping and dermo-cosmetology. Her research interests include pigmentation disorders, the gut: brain: skin axis, nutrition as a therapeutic tool in dermatologic disease management, healthy skin metabolomics and cosmeceutical formulation technologies. She is the founder of TASH360, South Africa’s first integrative dermatology centre offering cutting-edge technologies and advanced diagnostic testing, as well as root4: high-performance, results-driven skincare and nutraceuticals marrying advanced science and safety. She is an active member of the DSSA, the SASDS, the VSSA and the Xeroderma Pigmentosum Society.